BUILDING OUR FUTURE: DO NOT STOP FOR PANDEMICS
Written by: Thakshila Dasanayake
The ongoing COVID-19 pandemic has brought numerous challenges to people and the delivery of health care services. It has upended communities and significantly altered the everyday lives of millions of people across the globe. Sri Lanka reported its first COVID-19 case on March 11, 2020. From that date, the country managed to flatten the COVID-19 curve until April 2021, but cases continued to rise afterward until September 2021, dramatically (Official website for Sri Lanka’s response to COVID-19, 2020). Currently, the country is facing the third wave of the pandemic with much more severe consequences. As of November 26, 2021, Sri Lanka has reported 560,833 confirmed cases with 14,232 deaths (Health Promotion Bureau, 2021).
Making motherhood safer should be a top priority of any country, as it lies in the future of a nation. Sri Lanka managed to maintain satisfactory maternal and child health care services with low maternal and infant mortality indices as a country with a robust, free health care system and a talented workforce (Family Health Bureau, 2021). Undoubtedly, pregnancy is a difficult journey by nature and a sensitive period a woman experiences in her life course, and the COVID-19 pandemic has amplified those difficulties. With the collaboration of other responsible institutions, the Family Health Bureau (FHB), the focal point of maternal and child health in Sri Lanka, has taken several initiatives to battle the pandemic to ensure uninterrupted maternal and child health care services.
A national protocol was developed to provide continued antenatal care to all newly registered pregnant mothers, including those with high-risk pregnancies. According to this, all the categories such as mothers with high-risk pregnancies, mothers with and without infection, and COVID-suspected mothers are managed at hospitals, field clinics, by home visits, or via telephonic monitoring where necessary. Neither curfew nor quarantine stops them from visiting postpartum mothers if needed. Having a protocol is essential and convenient to ensure that similar care strategies are implemented all over the country. The collaboration of public health midwives, medical officers of health, provincial director of health services, regional director of health services, and public health nursing sisters is noteworthy.
It is crucial to tackling the associated negative impacts because mothers have been faced with unpleasant experiences of gender-based violence due to mobility restrictions and being confined to their homes for an ever-increasing amount of time. A survey revealed that verbal abuse, physical abuse, and sexual abuse were encountered by 76.8%, 7.8%, and 5.6%, respectively. Furthermore, the survey revealed that the main perpetrators were neighbors (49%), parents (25%), and intimate partners (24%) (Phakathi, 2020). Another negative impact is that mental health problems are on the rise among women during the pandemic period. A descriptive cross-sectional study conducted at Castel Hospital for Women, Sri Lanka, reported that 15.5% had anxiety and 19.5% had depression during this pandemic period, and more victims were young pregnant mothers (age 18–25 years) at 45.5% (Patabendige et al., 2020).
Gender-based violence support services such as safe homes and temporary shelters have been provided through the “Mithuru Piyasa/Natpu Nilayam” centers located at many hospitals across the country to ensure women and children’s safety and other survivors. As there was an overwhelming need for such services during the pandemic, national supplementary guidelines were issued to advise the staff on operating these facilities with adequate safety measures (De Silva et al., 2020).
Nearly two years into the pandemic, the government has made many efforts, yet much more needs to be done to address the pandemic’s ever-changing conditions. Even though suitable measures have been taken from the start of the pandemic until September 21, 2021, almost 5,000 pregnant women have been infected with the coronavirus, and about 200 of them are currently seeking treatment in hospitals, while 52 have died as a result of the condition. All of the fatalities took place after May 20, 2021, around the middle of the third wave (ColomboPage Sri Lanka Internet Newspaper, 2021). But there was no reliable record found of neonatal or child deaths in Sri Lanka. According to the UNFPA, COVID-19-related disruptions in health services have resulted in more than 228,000 more deaths among children under the age of five in the six main South Asian nations (Afghanistan, Bangladesh, Nepal, India, Pakistan, and Sri Lanka) by the end of 2020, compared to 2019. Maternal mortality is also expected to rise by 16%, with 7,750 additional deaths in India and over 2,000 additional deaths in Pakistan, for a total of approximately 11,000 additional maternal deaths in South Asia (UNFPA, 2021).
Governments must move quickly to ensure that mothers and newborns continue to receive the routine and emergency treatment they require as they create mechanisms to deal with the surge of COVID-19 patients. This involves ensuring that funding allocated to the COVID-19 response is used to guarantee continuity of care and enough financing for infection prevention and control supplies and equipment for healthcare staff. For women whose homes may lose income or whose usual service provider is no longer available, health services must remain financially and physically accessible.
Working to ensure the survival of mothers is both a human right and one of the vital development goals of a nation. Health workers on the front lines delivering health services to mothers and infants should be a part of policy response discussions and should have access to up-to-date, evidence-based information that can be disseminated via peer-to-peer networks and mobile applications. In the case of obstetric emergencies, referral networks and transportation must continue to function, and hospitals must monitor, isolate, and treat infected pregnant women effectively. Women of reproductive age and pregnant women require additional advice, which must be successfully delivered to them in their local languages. Offering services with dignity and respect should be a top priority during confusing and stressful times like this. As the mass media plays a massive role in today’s society, programs and talk shows with health professionals on television provide information on the early signs and prevention of COVID-19, and obstetric danger signs are common. Facebook and Instagram also provide reliable updates, improving health-seeking behavior at a community level.
At the same time, the government should collect data on the equity of care delivery and unaddressed issues to implement protective measures and determine what public health and healthcare risks are being introduced if schools reopen. Such data can be collected using rapid response surveys. The government can use this data to evaluate the effectiveness of the interventions, mental health issues, and risks associated with the implemented strategies. Comprehensive national-wide surveys are timely and crucial to getting a generalized understanding of the issues and future of this population. It is recommended that the government scrutinize this dynamic situation, gather and analyze data, develop and modify interim guidelines for delivering MCH services, and safeguard the nation’s future.
ColomboPage Sri Lanka Internet Newspaper (2021) Sri Lanka : Sri Lanka fully vaccinates 90% of pregnant women against COVID-19, ColomboPage. Available at: http://www.colombopage.com/archive_21B/Sep21_1632244790CH.php (Accessed: 31 October 2021).
Family Health Bureau (2021) Family Health Bureau, Family Health Bureau. Available at: https://www.fhb.health.gov.lk/index.php/en/ (Accessed: 26 November 2021).
Health Promotion Bureau (2021) Coronavirus (COVID-19) Sri Lanka – Analytics Dashboard. Available at: https://hpb.health.gov.lk/covid19-dashboard/ (Accessed: 26 November 2021).
Patabendige, M. et al. (2020) ‘Psychological impact of the COVID-19 pandemic among pregnant women in Sri Lanka’, International Journal of Gynecology and Obstetrics, 151(1), pp. 150–153. doi:10.1002/ijgo.13335.
Phakathi, M. (2020) Report Shows Sri Lanka has Escalation of Violence During COVID-19 Lockdown | Inter Press Service, Inter Press Service. Available at: http://www.ipsnews.net/2020/08/report-shows-sri-lanka-escalation-violence-covid-19-lockdown/ (Accessed: 28 January 2021).
De Silva, C. et al. (2020) ‘Continuing maternal and child health (MCH) services during COVID-19: activities, challenges and the lessons learnt’, Journal of the College of Community Physicians of Sri Lanka, 26(5). doi:10.4038/jccpsl.v26i5.8347.
UNFPA (2021) UNFPA Asiapacific. Available at: https://asiapacific.unfpa.org/en/news/disruptions-health-services-due-covid-19-%E2%80%9Cmay-have-contributed-additional-239000-child-and (Accessed: 26 November 2021).